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Dossou AJ, Fandohan AB, Omara T, Chippaux JP. Comprehensive Review of Epidemiology and Treatment of Snakebite Envenomation in West Africa: Case of Benin. J Trop Med 2024; 2024:8357312. [PMID: 38623180 PMCID: PMC11018376 DOI: 10.1155/2024/8357312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024] Open
Abstract
Snakebite envenomation (SBE) constitutes a public health, social, and economic problem affecting poor communities in intertropical and subtropical regions. This review sought to synthesize literature on snakebite envenomation in Benin to highlight research perspectives and strategies for better management of the menace. A literature search performed in multidisciplinary electronic databases showed that the prevalence of SBE is high in Benin, but the incidences, associated morbidities, and mortalities are greatly underestimated. Most snake envenomations are by Echis ocellatus in Northern Benin during the rainy season. Adults involved in agricultural activities are the most affected. The absence of antivenin serum in the most affected areas explains the preference for alternative and traditional medicine as the first-line treatment for SBE in Benin. In conclusion, it would be imperative to revitalize the snakebite reporting system in order to have better epidemiological data and to develop a sustainable national strategy for the control and management of snakebite envenomation.
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Affiliation(s)
- Ayékotchami Jacques Dossou
- Research Unit in Forestry and Conservation of Bioresources, National University of Agriculture, School of Tropical Forestry, BP 43, Kétou, Benin
| | - Adandé Belarmain Fandohan
- Research Unit in Forestry and Conservation of Bioresources, National University of Agriculture, School of Tropical Forestry, BP 43, Kétou, Benin
| | - Timothy Omara
- Department of Chemistry, College of Natural Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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Hus KK, Buczkowicz J, Pietrowska M, Petrilla V, Petrillová M, Legáth J, Litschka-Koen T, Bocian A. Venom diversity in Naja mossambica: Insights from proteomic and immunochemical analyses reveal intraspecific differences. PLoS Negl Trop Dis 2024; 18:e0012057. [PMID: 38557658 PMCID: PMC11008852 DOI: 10.1371/journal.pntd.0012057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/11/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Intraspecific variations in snake venom composition have been extensively documented, contributing to the diverse clinical effects observed in envenomed patients. Understanding these variations is essential for developing effective snakebite management strategies and targeted antivenom therapies. We aimed to comprehensively investigate venoms from three distinct populations of N. mossambica from Eswatini, Limpopo, and KwaZulu-Natal regions in Africa in terms of their protein composition and reactivity with three commercial antivenoms (SAIMR polyvalent, EchiTAb+ICP, and Antivipmyn Africa). METHODOLOGY/PRINCIPAL FINDINGS Naja mossambica venoms from Eswatini region exhibited the highest content of neurotoxic proteins, constituting 20.70% of all venom proteins, compared to Limpopo (13.91%) and KwaZulu-Natal (12.80%), and was characterized by the highest diversity of neurotoxic proteins, including neurotoxic 3FTxs, Kunitz-type inhibitors, vespryns, and mamba intestinal toxin 1. KwaZulu-Natal population exhibited considerably lower cytotoxic 3FTx, higher PLA2 content, and significant diversity in low-abundant proteins. Conversely, Limpopo venoms demonstrated the least diversity as demonstrated by electrophoretic and mass spectrometry analyses. Immunochemical assessments unveiled differences in venom-antivenom reactivity, particularly concerning low-abundance proteins. EchiTAb+ICP antivenom demonstrated superior reactivity in serial dilution ELISA assays compared to SAIMR polyvalent. CONCLUSIONS/SIGNIFICANCE Our findings reveal a substantial presence of neurotoxic proteins in N. mossambica venoms, challenging previous understandings of their composition. Additionally, the detection of numerous peptides aligning to uncharacterized proteins or proteins with unknown functions underscores a critical issue with existing venom protein databases, emphasizing the substantial gaps in our knowledge of snake venom protein components. This underscores the need for enhanced research in this domain. Moreover, our in vitro immunological assays suggest EchiTAb+ICP's potential as an alternative to SAIMR antivenom, requiring confirmation through prospective in vivo neutralization studies.
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Affiliation(s)
- Konrad K. Hus
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, Rzeszow, Poland
| | - Justyna Buczkowicz
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, Rzeszow, Poland
| | - Monika Pietrowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Vladimír Petrilla
- Department of Biology and Physiology, University of Veterinary Medicine and Pharmacy, Košice, Slovakia
- Zoological Department, Zoological Garden Košice, Košice-Kavečany, Slovakia
| | - Monika Petrillová
- Department of General Competencies, University of Veterinary Medicine and Pharmacy, Košice, Slovakia
| | - Jaroslav Legáth
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, Rzeszow, Poland
- Department of Pharmacology and Toxicology, University of Veterinary Medicine and Pharmacy, Košice, Slovakia
| | | | - Aleksandra Bocian
- Department of Biotechnology and Bioinformatics, Faculty of Chemistry, Rzeszow University of Technology, Rzeszow, Poland
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TANKPINOU ZOUMENOU H, CHIPPAUX JP, FACHEHOUN P, PRIULI G, MASSOUGBODJI A. [Assessment of a therapeutic protocol for the management of snakebite envenomations in Benin]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i4.2023.451. [PMID: 38390023 PMCID: PMC10879887 DOI: 10.48327/mtsi.v3i4.2023.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/19/2023] [Indexed: 02/24/2024]
Abstract
Introduction Snakebite envenomation is a major public health issue in Sub-Saharan Africa (SSA). Antivenoms are the only etiological treatment. However, the dose recommended by the manufacturer (2 vials renewed every 2 hours in case of persistent bleeding) is usually not applied due to the high cost which is borne only by the patient. Based on clinical presentation, we evaluated the administration of a single vial on admission (instead of 2 vials), which corresponds to the therapeutic protocol used in current practice in most health centers in Benin and beyond in SSA. Renewal of antivenom followed manufacturer's recommendation. Material and method The study took place in a first referral hospital in Tanguiéta, North Benin. All envenomed patients received a slow intravenous vial of Inoserp® Pan-Africa (IPA) upon arrival. A clinical assessment identical to that of inclusion was carried out 2, 4, 6, 12 and 24 hours later to assess the tolerance and efficacy of the IPA, as well as the need to readminister the antivenom. The occurrence, persistence or worsening of clinical hemorrhages or neurological disorders, the latter reflecting envenomation by elapids, systematically led to the injection of 2 or 4 vials of IPA, respectively. Signs of intolerance were sought before and after each administration of antivenom, then 2 weeks to 1 month after treatment, in order to estimate the incidence of adverse effects attributable to the antivenom. Efficacy of IPA was assessed by cessation of bleeding and/or normalization of whole blood coagulation test (WBCT) within 24 hours of initial administration. Results The study took place from July 31 to October 31, 2019. We received 53 cases of snakebites of which 43 were included. The median age was 21 [IQR: 18-31] years and the sex ratio (M/F) was 1.5. Farmers were the majority (48%). The median time to admission was 1 [IQR: 0-2] day. On admission, 32 patients (74%) presented hemostasis disorders marked by bleeding and/or abnormal WBCT. None of the patients showed neurological symptoms. The median time to normalization of WBCT was 24 [IQR: 4-72] hours. The median time to stop bleeding was 6 [IQR: 4-12] hours. In 3 of the 11 patients whose bleeding had stopped at H2, a recurrence occurred within the following 24 hours. In addition, 3 patients presented with late bleeding 24 hours after admission. Two patients (5%) died as a result of envenomation. Discussion/conclusion The simplified protocol represents a significant saving in the number of vials used, i.e. 1.8±0.4 vials per patient instead of the 2.4±0.2 which would have been necessary in these same patients treated according to the standard protocol (p = 2.6·10-4). However, in comparison with the results obtained during the previous clinical study, the cessation of bleeding is delayed, as is the normalization of the WBCT at the different follow-up times. In addition, the number of re-administrations of antivenom after H2 is higher in the light protocol than in the standard one, respectively 13 patients out of 43 treated versus 4 patients out of 59 (p = 0.006). There was no significant difference between the incidence of signs of early antivenom intolerance in this study compared to the previous one (16% and 11%, respectively; p = 0.79). This delay can put up to a third of patients at risk of complications. Despite its effectiveness and the antivenom savings made, it does not seem reasonable to recommend it.
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Hu Y, Lv C, Song X, Gan Y, Wang J, Hao W, He L, Chen Y, Han X, Yan S. Current Status and Influencing Factors of Snakebite Diagnosis and Treatment Knowledge Among Medical Staff in China: A Cross-Sectional Study. Int J Public Health 2023; 68:1606601. [PMID: 38146482 PMCID: PMC10749458 DOI: 10.3389/ijph.2023.1606601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
Objectives: This study aimed to determine the current status of the knowledge of diagnosis and treatment of snakebites among medical staff in China and its influencing factors. Methods: A cross-sectional survey of 12,581 medical staff was conducted in 12 provinces in China between June 2022 and February 2023. We analyzed the results using descriptive statistics, T-tests or analysis of variance, and a generalized linear model. Results: The average score of snakebite diagnosis and treatment knowledge among medical staff in China was 3.15 ± 2.15 out of a total score of 12. Through a generalized linear regression model, we found that gender, occupation, region, hospital level, work department, work tenure, training received in the diagnosis and treatment of snakebite, experience in snakebite diagnosis and treatment, availability of antivenom in the unit, and self-evaluation of snakebite treatment ability all affected the medical staff's scores of snakebite diagnosis and treatment knowledge. Conclusion: The knowledge level of snakebite diagnosis and treatment among Chinese medical staff is generally low, so it is imperative to conduct standardized snakebite diagnosis and treatment training for medical staff.
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Affiliation(s)
- Yanlan Hu
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Juntao Wang
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Wenjie Hao
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Lanfen He
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Yu Chen
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
| | - Xiaotong Han
- Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, Department of Emergency Medicine, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People’s Hospital, The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Shijiao Yan
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
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Werner RM, Soffa AN. Considerations for the development of a field-based medical device for the administration of adjunctive therapies for snakebite envenoming. Toxicon X 2023; 20:100169. [PMID: 37661997 PMCID: PMC10474190 DOI: 10.1016/j.toxcx.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023] Open
Abstract
The timely administration of antivenom is the most effective method currently available to reduce the burden of snakebite envenoming (SBE), a neglected tropical disease that most often affects rural agricultural global populations. There is increasing interest in the development of adjunctive small molecule and biologic therapeutics that target the most problematic venom components to bridge the time-gap between initial SBE and the administration antivenom. Unique combinations of these therapeutics could provide relief from the toxic effects of regional groupings of medically relevant snake species. The application a PRISMA/PICO literature search methodology demonstrated an increasing interest in the rapid administration of therapies to improve patient symptoms and outcomes after SBE. Advice from expert interviews and considerations regarding the potential routes of therapy administration, anatomical bite location, and species-specific venom delivery have provided a framework to identify ideal metrics and potential hurdles for the development of a field-based medical device that could be used immediately after SBE to deliver adjunctive therapies. The use of subcutaneous (SC) or intramuscular (IM) injection were identified as potential routes of administration of both small molecule and biologic therapies. The development of a field-based medical device for the delivery of adjunctive SBE therapies presents unique challenges that will require a collaborative and transdisciplinary approach to be successful.
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Chippaux JP, Ntone R, Benhammou D, Madec Y, Noël G, Perilhou A, Karl F, Amta P, Sanchez M, Matchim L, Clauteaux P, Eteki L, Ndifon M, Boum Y, Nkwescheu AS, Taieb F. Real life condition evaluation of Inoserp PAN-AFRICA antivenom effectiveness in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011707. [PMID: 37939111 PMCID: PMC10659212 DOI: 10.1371/journal.pntd.0011707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/20/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes. Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14-40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection. CONCLUSIONS/SIGNIFICANCE We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom. TRIAL REGISTRATION NCT03326492.
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Affiliation(s)
- Jean-Philippe Chippaux
- Université Paris Cité, Institut de Recherche pour le développement, MERIT, Paris, France
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | - David Benhammou
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Gaëlle Noël
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Anais Perilhou
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Fai Karl
- Epicentre Yaoundé, Yaoundé, Cameroon
| | | | - Marie Sanchez
- Institut Pasteur, Université Paris Cité, Data management core facility, Paris, France
| | | | - Pedro Clauteaux
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | | | - Yap Boum
- Epicentre Yaoundé, Yaoundé, Cameroon
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da Silva WRGB, de Siqueira Santos L, Lira D, de Oliveira Luna KP, Fook SML, Alves RRN. Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country. PLoS Negl Trop Dis 2023; 17:e0011708. [PMID: 37856557 PMCID: PMC10617728 DOI: 10.1371/journal.pntd.0011708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/31/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming.
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Affiliation(s)
- Weslley Ruan Guimarães Borges da Silva
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Bioinformatics, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas de Siqueira Santos
- Graduate Program in Geodetic Sciences and Geoinformation Technologies, Department of Cartographic Engineering, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Derick Lira
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Karla Patrícia de Oliveira Luna
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Science Teaching and Mathematics Education, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Cellular and Molecular Biology, Department of Molecular Biology, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Sayonara Maria Lia Fook
- Graduate Program in Public Health, Department of Pharmacy, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Rômulo Romeu Nóbrega Alves
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ethnobiology and Nature Conservation, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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Wafula ST, Namakula LN, Ninsiima LR, Ssekamatte NK, Walekhwa AW, Mugume IB, Musoke D. Barriers and opportunities for improving management of snakebites: Perspectives of healthcare workers in Northern Uganda. PLoS One 2023; 18:e0291032. [PMID: 37747844 PMCID: PMC10519583 DOI: 10.1371/journal.pone.0291032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Snakebites are a neglected public health problem that pose a significant burden on affected individuals and communities in many sub-Saharan African countries, including Uganda. However, the barriers and facilitators to snakebite management within healthcare settings are not as well understood and well-documented. The aim of this study was to explore the experiences and perspectives of healthcare workers involved in handling snakebite incidents at individual and health system levels in Arua and Gulu districts in Northern Uganda. We sought to understand how healthcare workers manage snakebite cases, what challenges they encounter, and what opportunities they perceive for improvement. METHODS We conducted a qualitative study using in-depth interviews with 18 healthcare workers from different cadres, seniority levels, and facility types. We used iterative thematic analysis to explore the management procedures, challenges, and opportunities for snakebite management. Using thematic analysis, we identified the overarching themes and subthemes related to snakebite management and associated barriers and opportunities. RESULTS The main barriers to snakebite management identified by healthcare workers were inadequate knowledge and skills; limited availability of antivenom; lack of protocols for snakebite management; delayed treatment-seeking for patients; and poor referral systems. The main opportunities for improvement were regular in-service training; increasing public education and awareness about snakebite prevention and management; and increased funding and research. CONCLUSION This study highlights the need for interventions to address the identified barriers while leveraging the existing opportunities to enhance snakebite management in Uganda. Specifically, we recommend the provision of regular training and support to healthcare workers, developing clinical guidelines, and improving the availability of antivenoms.
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Affiliation(s)
- Solomon T. Wafula
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Lydia N. Namakula
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lesley R. Ninsiima
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noah Kiwanuka Ssekamatte
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Abel W. Walekhwa
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Diseases Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - David Musoke
- Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Guile L, Lee A, Gutiérrez JM. Factors associated with mortality after snakebite envenoming in children: a scoping review. Trans R Soc Trop Med Hyg 2023; 117:617-627. [PMID: 37264929 PMCID: PMC10472879 DOI: 10.1093/trstmh/trad031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
Snakebite envenoming is an important public health issue in many tropical and subtropical countries, where the burden of morbidity and mortality falls particularly on impoverished rural communities. Children are an especially vulnerable group. This scoping review provides an overview of the extent, type and content of peer-reviewed evidence regarding factors associated with mortality in snakebite-envenomed children. A comprehensive literature search of MEDLINE and the Global Index Medicus yielded 623 articles, of which 15 met the criteria for inclusion; 67% of studies were conducted in India, with the remaining studies taking place in Papua New Guinea, Morocco and The Gambia. There was a notable scarcity of eligible studies from sub-Saharan Africa and Latin America despite the high burden of envenoming in these regions. The risk factors for mortality that were identified by the greatest number of studies were younger patient age (n=4), delay in administration of antivenom (n=4) and acute kidney injury (n=3). Identification of poor prognostic factors can assist clinicians in making timely referrals to centres with paediatric critical care capability. Future research must address the lack of studies from key geographical regions so that evidence-based improvements to the care of this vulnerable group can be implemented.
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Affiliation(s)
- Lucy Guile
- Peninsula Medical School, University of Plymouth, Plymouth PL6 8BU, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Adrienne Lee
- Peninsula Medical School, University of Plymouth, Plymouth PL6 8BU, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - José María Gutiérrez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José 11501, Costa Rica
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Bhaumik S, Norton R, Jagnoor J. Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment. BMC PRIMARY CARE 2023; 24:160. [PMID: 37563556 PMCID: PMC10416377 DOI: 10.1186/s12875-023-02109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified 'health systems strengthening' as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey - 4), to assess structural capacity and continuum of snakebite care in primary health care system in India. METHODOLOGY We evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not. RESULTS No state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains. CONCLUSION Comprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
- Injury Division, The George Institute for Global Health, New Delhi, India.
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Tiwari N, Jaimini A, Jain GK, Aggarwal G, Mittal G. Evaluation of three different 99mTc-based mock-venom agents for lymphoscintigraphy studies in preclinical models of peripheral snakebite envenomation. J Pharmacol Toxicol Methods 2023:107280. [PMID: 37295617 DOI: 10.1016/j.vascn.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
Snakebite envenomation is one of the major public health concerns across many countries; with the WHO designating it as a 'priority neglected tropical disease' and stressing for a need to develop novel therapeutic strategies to reduce death and disability rate by end of 2030. Since a major component of venom; the high molecular weight (HMw) toxins enter the bloodstream through lymphatic system, research is focusing on modulating the lymphatic flow rate after topical application of suitable drug candidates. Present study compared the suitability of three radiopharmaceutical agents, namely 99mTc-Sulfur colloid (SC), 99mTc-Phytate (Phy) and 99mTc-Human serum albumin (HSA), to be used as mock-venom agent in studying modulation in lymphatic flow rate in preclinical models of peripheral snakebite envenomation using lymphoscintigraphy studies. The study was performed in 72 Sprague Dawley rats; divided into six groups of 12 rats each. Control groups were given intradermal injection (1.29-1.48 MBq in 100 μl normal saline) of either 99mTc-Phy/ 99mTc-SC/ 99mTc-HSA into the tail as 'mock-venom'. In respective test groups, commercially available topical formulation (Anobliss® Cream) containing Nifedipine (Nif; 0.3% w/w) and Lidocaine (Lid; 1.5% w/w) was applied topically over the animals' lower body (tail and hind limbs) immediately within 20s of administering intradermal injection of the radiopharmaceutical. Any modulation in lymph transit time from periphery to systemic circulation was assessed using lymphoscintigraphy by taking dynamic gamma-scintigraphy images of 60s each till 1 h post-injection of the test radiopharmaceuticals. Significant difference in movement of the three radiopharmaceuticals was noted in terms of their lymphatic movement. 99mTc-Phy did not show significant travel through the lymphatics and the liver was faintly visualized in control as well as test intervention groups. In case of 99mTc-SC, significant changes in movement of the radiotracer after topical application of Nif/Lid in the test intervention groups were clearly noted in comparison to control (P < 0.05). Multiple numbers of lymph nodes (LNs) could be clearly visualized in control (5 ± 1 LNs) and test intervention groups (3 ± 1 LNs). Liver uptake was more prominent in control animals and it reduced significantly in test intervention groups. On the other hand, 99mTc-HSA showed lesser number of lymph nodes and higher accumulation in liver as compared to 99mTc-SC, suggesting very fast movement of this radiopharmaceutical. Results indicates that 99mTc-SC could be used as a suitable agent to mimic lymphatic transit behavior of HMw toxin components of snake venom and could therefore be used as a model in studying the effect of any test pharmacological intervention in modulating lymphatic transit rate. Additional advantage could be a significant reduction in the need for sacrificing large number of animals, particularly during initial screening phase of drug development cycle.
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Affiliation(s)
- Nidhi Tiwari
- Department of Combat Sciences, Institute of Nuclear Medicine and Allied Sciences, Defence Research & Development Organisation, New Delhi 110054, India; Delhi Pharmaceutical Sciences and Research University (DPSRU), Pushp Vihar, New Delhi 110017, India
| | - Abhinav Jaimini
- Department of Combat Sciences, Institute of Nuclear Medicine and Allied Sciences, Defence Research & Development Organisation, New Delhi 110054, India
| | - Gaurav Kumar Jain
- Delhi Pharmaceutical Sciences and Research University (DPSRU), Pushp Vihar, New Delhi 110017, India
| | - Geeta Aggarwal
- Delhi Pharmaceutical Sciences and Research University (DPSRU), Pushp Vihar, New Delhi 110017, India
| | - Gaurav Mittal
- Department of Combat Sciences, Institute of Nuclear Medicine and Allied Sciences, Defence Research & Development Organisation, New Delhi 110054, India.
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Comparative venom toxin analyses of Nigerian viperidae and elapidae snakes. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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13
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Tan CH, Wong KY, Huang LK, Tan KY, Tan NH, Wu WG. Snake Venomics and Antivenomics of Cape Cobra ( Naja nivea) from South Africa: Insights into Venom Toxicity and Cross-Neutralization Activity. Toxins (Basel) 2022; 14:toxins14120860. [PMID: 36548757 PMCID: PMC9783313 DOI: 10.3390/toxins14120860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Naja nivea (Cape Cobra) is endemic to southern Africa. Envenoming by N. nivea is neurotoxic, resulting in fatal paralysis. Its venom composition, however, has not been studied in depth, and specific antivenoms against it remain limited in supply. Applying a protein decomplexation approach, this study unveiled the venom proteome of N. nivea from South Africa. The major components in the venom are cytotoxins/cardiotoxins (~75.6% of total venom proteins) and alpha-neurotoxins (~7.4%), which belong to the three-finger toxin family. Intriguingly, phospholipase A2 (PLA2) was undetected-this is a unique venom phenotype increasingly recognized in the African cobras of the Uraeus subgenus. The work further showed that VINS African Polyvalent Antivenom (VAPAV) exhibited cross-reactivity toward the venom and immunorecognized its toxin fractions. In mice, VAPAV was moderately efficacious in cross-neutralizing the venom lethality with a potency of 0.51 mg/mL (amount of venom completely neutralized per milliliter of antivenom). In the challenge-rescue model, VAPAV prevented death in 75% of experimentally envenomed mice, with slow recovery from neurotoxicity up to 24 h. The finding suggests the potential para-specific utility of VAPAV for N. nivea envenoming, although a higher dose or repeated administration of the antivenom may be required to fully reverse the neurotoxic effect of the venom.
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Affiliation(s)
- Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Institute of Bioinformatics and Structural Biology, Department of Life Science, National Tsing Hua University, Hsinchu 300044, Taiwan
- Correspondence: or
| | - Kin Ying Wong
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Institute of Bioinformatics and Structural Biology, Department of Life Science, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Li-Kun Huang
- Institute of Bioinformatics and Structural Biology, Department of Life Science, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Kae Yi Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Nget Hong Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Wen-Guey Wu
- Institute of Bioinformatics and Structural Biology, Department of Life Science, National Tsing Hua University, Hsinchu 300044, Taiwan
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Abstract
Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900-78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5-1.0) per 100,000 and represents a 36% (2-49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3-5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO's goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.
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15
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Bhaumik S, Kadam P, Pati S, Di Tanna GL, Jagnoor J. Community-based interventions for bite prevention, improved care-seeking and appropriate first aid in snakebite. Hippokratia 2022. [DOI: 10.1002/14651858.cd015097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute of Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Meta-research and Evidence Synthesis Unit; The George Institute for Global Health; New Delhi India
| | | | - Sanghamitra Pati
- Regional Medical Research Centre; Indian Institute of Medical Research; Bhubaneswar India
| | - Gian Luca Di Tanna
- Meta-research and Evidence Synthesis Unit; The George Institute for Global Health; Sydney Australia
| | - Jagnoor Jagnoor
- The George Institute of Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Injury Division; The George Institute for Global Health; New Delhi India
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Tiwari N, Aggarwal G, Jain GK, Mittal G. Multi-drug loaded microneedles for emergency treatment of snakebite envenomation. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Wang S, Yang W, Shi W, Chen F, Shen F, Zhang M, Su Q, Shi C, Yu Q, Chen T. Investigations on the Changes of Serum Proteins in Rabbits after Trimeresurus stejnegeri Venom Injection via Mass Spectrometry-Based Proteomics. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:9239662. [PMID: 35783526 PMCID: PMC9249469 DOI: 10.1155/2022/9239662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
Purpose There are few studies on protein phosphorylation in the process of snake poisoning. The purpose of this study was to investigate the toxic mechanism of Trimeresurus stejnegeri at the protein level by determining the differential expression of phosphorylated proteins in rabbits after poisoning using proteomics. Methods The Trimeresurus stejnegeri venom model in rabbits was established by intramuscular injection of 20 mg/kg venom. The serum was collected and the differential expression of phosphorylated proteins in the serum was determined by the iTRAQ technology, TiO2 enriched phosphorylated peptides, and the mass spectrometry analysis. The functional analysis was conducted using ClueGO software and the related mechanism was evaluated by the network analysis of biological interaction. The expression level of related proteins was determined by the Western blotting assay. Results Compared to the control group, 77 differentially expressed proteins were observed in the model group. These proteins were closely associated with the complement and agglomerate cascade signaling pathways, the HIF signaling pathway, the pentose phosphate pathway, and the cholesterol metabolism signaling pathway. According to the results of network analysis, TF and SCL16A1 were determined as the core proteins, which were identified by the Western blotting assay. Conclusion The present study provided valuable phosphorylation signal transduction resources for investigating the toxic mechanism and the therapies for Trimeresurus stejnegeri poisoning.
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Affiliation(s)
- Shijun Wang
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Weilian Yang
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Wanling Shi
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Fuwei Chen
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Fanghua Shen
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Meiji Zhang
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Qiuxiang Su
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Chao Shi
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Qinyao Yu
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Tao Chen
- Surgery of Traditional Chinese Medicine, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
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Computer-Aided Analysis of West Sub-Saharan Africa Snakes Venom towards the Design of Epitope-Based Poly-Specific Antivenoms. Toxins (Basel) 2022; 14:toxins14060418. [PMID: 35737079 PMCID: PMC9229730 DOI: 10.3390/toxins14060418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
Snakebite envenomation is a neglected tropical disease that causes over 100,000 deaths each year. The only effective treatment consists of antivenoms derived from animal sera, but these have been deemed with highly variable potency and are usually inaccessible and too costly for victims. The production of antivenoms by venom-independent techniques, such as the immunization with multi-epitope constructs, could circumvent those drawbacks. Herein, we present a knowledge-based pipeline to prioritize potential epitopes of therapeutic relevance from toxins of medically important snakes in West Sub-Saharan Africa. It is mainly based on sequence conservation and protein structural features. The ultimately selected 41 epitopes originate from 11 out of 16 snake species considered of highest medical importance in the region and 3 out of 10 of those considered as secondary medical importance. Echis ocellatus, responsible for the highest casualties in the area, would be covered by 12 different epitopes. Remarkably, this pipeline is versatile and customizable for the analysis of snake venom sequences from any other region of the world.
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On characterizing the Red-headed Krait (Bungarus flaviceps) venom: Decomplexation proteomics, immunoreactivity and toxicity cross-neutralization by hetero-specific antivenoms. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. PART D, GENOMICS & PROTEOMICS 2022; 43:101006. [PMID: 35717758 DOI: 10.1016/j.cbd.2022.101006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/26/2022]
Abstract
The Red-headed Krait (Bungarus flaviceps) is a medically important venomous snake species in Southeast Asia, while there is no specific antivenom available for its envenoming. This study investigated the venom composition through a decomplexation proteomic approach, and examined the immunoreactivity as well as cross-neutralization efficacy of two hetero-specific krait antivenoms, Bungarus candidus Monovalent Antivenom (BcMAV) and Bungarus fasciatus Monovalent Antivenom (BfMAV), against the venom of B. flaviceps from Peninsular Malaysia. A total of 43 non-redundant proteoforms belonging to 10 toxin families were identified in the venom proteome, which is dominated by phospholipases A2 including beta-bungarotoxin lethal subunit (56.20 % of total venom proteins), Kunitz-type serine protease inhibitors (19.40 %), metalloproteinases (12.85 %) and three-finger toxins (7.73 %). The proteome varied in quantitative aspect from the earlier reported Indonesian (Sumatran) sample, suggesting geographical venom variation. BcMAV and BfMAV were immunoreactive toward the B. flaviceps venom, with BcMAV being more efficacious in immunological binding. Both antivenoms cross-neutralized the venom lethality with varying efficacy, where BcMAV was more potent than BfMAV by ~13 times (normalized potency: 38.04 mg/g vs. 2.73 mg/g, defined as the venom amount completely neutralized by one-gram antivenom protein), supporting the potential utility of BcMAV for para-specific neutralization against B. flaviceps venom.
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Lam A, Touré A, Ly M, Bah F, Sène D, Cabral M, Fall M, Chippaux JP. Place du Centre Anti Poison du Sénégal dans la collecte des données et la prise en charge des morsures de serpent. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Michael G. Early severity predictors of snakebite envenomation in the southern region of Tunisia. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.342667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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22
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Sanni UA, Lawal TO, Musa TL, Alege A, Na'uzo AM. Prevalence and Outcome of Snake Bites Among Children Admitted in the Emergency Pediatric Unit, Federal Medical Centre, Birnin Kebbi, Nigeria. Cureus 2021; 13:e17413. [PMID: 34589324 PMCID: PMC8459746 DOI: 10.7759/cureus.17413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Snakebites are common and constitute an important health problem in many countries of the world, with the greatest burden occurring in rural areas of Asia and Sub-Saharan Africa. They were classified by the World Health Organization as category A of neglected tropical diseases. Most studies on snake envenoming in Nigeria were among adult populations with few among children. This study assessed the prevalence and outcome of snakebite among children in Federal Medical Centre, Birnin Kebbi. Methods This was a four-year retrospective study in which the medical records of patients with managed snakebite were reviewed. A study proforma was used to obtain information on socio-demographic characteristics, site of the bite, features of envenoming, pre-hospitalization intervention, hospital treatment, length of hospitalization, and outcome of treatment of the patients. Results There were 19 snakebite cases out of 5,195 admissions during the period under review, giving a prevalence of 0.0037 (3.7/1000) with a male:female ratio of 2:1. The majority (66.7%) of the children were aged between 11 and 15 years and the mean (± SD) age of the study population was 10.5 (± 3.3) years. The lower limb was the site of bite in 10 (55.6%) of the patients and clinical features included local pain (100%), local swelling of varying magnitude (16 (88.9%)), spontaneous bleeding eight (44.4%) among others. Ten (55.65%) patients presented after four hours of bite and the mean (±SD) duration of hospitalization was 2.11 (±0.58) days. Most (77.8%) received at least one form of pre-hospital care while only 66.7% received polyvalent anti-snake venin. The case fatality rate was 5.6% while 55.6% of patients signed against medical advice. Conclusion There was a low hospital prevalence of snakebite in children in the present study location with associated low mortality but a high rate of discharge against medical advice. Most of the patients had a pre-hospital intervention and anti-snake venin is not readily accessible.
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Affiliation(s)
- Usman A Sanni
- Paediatrics, Federal Medical Centre, Birnin Kebbi, NGA
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Leiva CL, Geoghegan P, Lammer M, Cangelosi A, Mariconda V, Celi AB, Brero ML, Chacana P. In vivo neutralization of bee venom lethality by IgY antibodies. Mol Immunol 2021; 135:183-190. [PMID: 33930713 DOI: 10.1016/j.molimm.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
Bee venom is a complex mixture of molecules, among which melittin and phospholipase A2 (PLA2) are the toxic components involved in envenoming accidents with multiple honeybee stings. Traditionally, the treatment of envenomings has been based on the administration of specific antibodies to neutralize the deleterious effects of toxins. An alternative to mammalian polyclonal antibodies is the use of egg yolk immunoglobulins (IgY) due to their advantages regarding animal welfare and lower costs of production as compared to the conventional production methods. In this work, a novel composition containing specific IgY antibodies was developed. After four immunizations, IgY extracted from the egg yolks was able to recognize several components of the bee venom, including melittin and PLA2. The performance of IgY to neutralize the lethal activity was evaluated in a mouse model by using one median lethal dose (LD50) of the bee venom. The effective dose of the IgY extract was determined as 30.66 μg/mg. These results demonstrate the feasibility to produce IgY-based antivenoms to treat envenomings by multiple bee stings.
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Affiliation(s)
- Carlos Leónidas Leiva
- Instituto de Patobiología, Instituto Nacional de Tecnología Agropecuaria, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina; Instituto de Patobiología Veterinaria, UEDD INTA-CONICET, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina.
| | - Patricia Geoghegan
- Centro Nacional de Control de Calidad de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez, Sarsfield 563, CABA, Argentina.
| | - Mónica Lammer
- Centro Nacional de Control de Calidad de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez, Sarsfield 563, CABA, Argentina.
| | - Adriana Cangelosi
- Centro Nacional de Control de Calidad de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez, Sarsfield 563, CABA, Argentina.
| | - Virginia Mariconda
- Centro Nacional de Control de Calidad de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez, Sarsfield 563, CABA, Argentina.
| | - Ana Beatriz Celi
- Instituto de Patobiología, Instituto Nacional de Tecnología Agropecuaria, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina; Instituto de Patobiología Veterinaria, UEDD INTA-CONICET, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina.
| | - María Luisa Brero
- Centro Nacional de Control de Calidad de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Av. Vélez, Sarsfield 563, CABA, Argentina.
| | - Pablo Chacana
- Instituto de Patobiología, Instituto Nacional de Tecnología Agropecuaria, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina; Instituto de Patobiología Veterinaria, UEDD INTA-CONICET, Nicolas Repetto y Los Reseros S/N, Hurlingham, Buenos Aires, Argentina.
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Cristino JS, Salazar GM, Machado VA, Honorato E, Farias AS, Vissoci JRN, Silva Neto AV, Lacerda M, Wen FH, Monteiro WM, Sachett JAG. A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study). PLoS Negl Trop Dis 2021; 15:e0009245. [PMID: 33661895 PMCID: PMC7963098 DOI: 10.1371/journal.pntd.0009245] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.
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Affiliation(s)
- Joseir Saturnino Cristino
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Guilherme Maciel Salazar
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Vinícius Azevedo Machado
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Eduardo Honorato
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Altair Seabra Farias
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Alexandre Vilhena Silva Neto
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marcus Lacerda
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Fan Hui Wen
- Bioindustrial Centre, Butantan Institute, São Paulo, Brazil
| | - Wuelton Marcelo Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus, Brazil
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25
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Michael G. Snakebite profile from a tertiary care setup in a largely rural setting in the hills of North-West India. J Family Med Prim Care 2021; 10:4628. [PMID: 35280643 PMCID: PMC8884291 DOI: 10.4103/jfmpc.jfmpc_1853_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
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26
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Rasoulinasab F, Rasoulinasab M, Shahbazzadeh D, Asadi A, Kaboli M. Comparison of venom from wild and long-term captive Gloydius caucasicus and the neutralization capacity of antivenom produced in rabbits immunized with captive venom. Heliyon 2020; 6:e05717. [PMID: 33364492 PMCID: PMC7750379 DOI: 10.1016/j.heliyon.2020.e05717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/07/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
Gloydius caucasicus (NIKOLSKY, 1916) is a member of the Viperidae family in Iran. Comprehensive understanding of the toxigenic characteristics of snake venom is important for clinical monitoring of snakebite patients and effective therapy. We compared the toxic activities of venoms and the neutralization capacity of antivenoms produced with venoms from wild adult (WA) with long-term captive adult (LCA) of G. caucasicus in order to obtain more effective antivenom from LCA in therapy, and subsequently protect G. caucasicus from overharvesting for its venom, which poses a real threat of extinction for the species. Our results showed that LD50 of WA and LCA were 16.8 μg/dose and 17.7 μg/dose, respectively. Lower hemorrhagic and necrotic (p ≥ 0.05), and higher coagulative and edematogenic activities (p ≤ 0.05) were observed in WA compared with LCA venom. Also, captive-born neonates exhibited weaker toxic activities compared with captive adult snakes, which could be an age-related difference. Study data illustrated that effective capacity of LCA antivenom to neutralize the toxic activities of WA viper venom. According to the results, about 0.4-4 μl of LCA antivenom is required to neutralize the toxic activities of 1 μg of WA venom, indicating its efficacy in treatment of snakebites in humans. On this basis, it is recommended that capture of wild snakes for their venom be discontinued to reduce their future extinction risk.
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Affiliation(s)
- Fatemeh Rasoulinasab
- Department of Environmental Science, Faculty of Natural Resources, College of Agriculture & Natural Resources, University of Tehran, Iran
| | - Masoumeh Rasoulinasab
- Department of Bacteriology, Pasteur Institute of Iran, No. 69, Pasteur Ave, Tehran, Iran
| | - Delavar Shahbazzadeh
- Biotechnology Research Center (BRC), Pasteur Institute of Iran, No. 69, Pasteur Ave, Tehran, Iran
| | - Atefeh Asadi
- CEFE, University of Montpellier, University of Paul Valéry Montpellier 3, PSL-EPHE (Biogéographie et Ecologie des Vertébrés), CNRS, IRD, Montpellier, France
| | - Mohammad Kaboli
- Department of Environmental Science, Faculty of Natural Resources, College of Agriculture & Natural Resources, University of Tehran, Iran
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Dong D, Deng Z, Yan Z, Mao W, Yi J, Song M, Li Q, Chen J, Chen Q, Liu L, Wang X, Huang X, Wang W. Oxidative stress and antioxidant defense in detoxification systems of snake venom-induced toxicity. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200053. [PMID: 33117427 PMCID: PMC7574533 DOI: 10.1590/1678-9199-jvatitd-2020-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Snakebites remain a major life-threatening event worldwide. It is still difficult to make a positive identification of snake species by clinicians in both Western medicine and Chinese medicine. The main reason for this is a shortage of diagnostic biomarkers and lack of knowledge about pathways of venom-induced toxicity. In traditional Chinese medicine, snakebites are considered to be treated with wind, fire, and wind-fire toxin, but additional studies are required. Methods: Cases of snakebite seen at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were grouped as follows: fire toxin - including four cases of bites by Agkistrodon acutus and three bites by Trimeresurus stejnegeri - and wind-fire toxin - four cases of bites by vipers and three bites by cobras. Serum protein quantification was performed using LC-MS/MS. Differential abundance proteins (DAPs) were identified from comparison of snakebites of each snake species and healthy controls. The protein interaction network was constructed using STITCH database. Results: Principal component analysis and hierarchical clustering of 474 unique proteins exhibited protein expression profiles of wind-fire toxins that are distinct from that of fire toxins. Ninety-three DAPs were identified in each snakebite subgroup as compared with healthy control, of which 38 proteins were found to have significantly different expression levels and 55 proteins displayed no expression in one subgroup, by subgroup comparison. GO analysis revealed that the DAPs participated in bicarbonate/oxygen transport and hydrogen peroxide catabolic process, and affected carbon-oxygen lyase activity and heme binding. Thirty DAPs directly or indirectly acted on hydrogen peroxide in the interaction network of proteins and drug compounds. The network was clustered into four groups: lipid metabolism and transport; IGF-mediated growth; oxygen transport; and innate immunity. Conclusions: Our results show that the pathways of snake venom-induced toxicity may form a protein network of antioxidant defense by regulating oxidative stress through interaction with hydrogen peroxide.
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Affiliation(s)
- Degang Dong
- School of Life Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Innovative Chinese Medicine Research Institute, Shanghai University of Chinese Medicine, Shanghai, China
| | - Zhongping Deng
- Innovative Chinese Medicine Research Institute, Shanghai University of Chinese Medicine, Shanghai, China
| | - Zhangren Yan
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wenli Mao
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun Yi
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Mei Song
- Science and Technology College, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qiang Li
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun Chen
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qi Chen
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Liang Liu
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xi Wang
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xiuqin Huang
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wanchun Wang
- Southern Snake Bite Control Center, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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28
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Diniz-Sousa R, Moraes JDN, Rodrigues-da-Silva TM, Oliveira CS, Caldeira CADS. A brief review on the natural history, venomics and the medical importance of bushmaster ( Lachesis) pit viper snakes. Toxicon X 2020; 7:100053. [PMID: 32793880 PMCID: PMC7408722 DOI: 10.1016/j.toxcx.2020.100053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022] Open
Abstract
Snakes of the genus Lachesis, commonly known as bushmasters, are the largest venomous snakes in the Americas. Because these snakes have their habitats in areas of remote forests they are difficult to find, and consequently there are few studies of Lachesis taxa in their natural ecosystems. Bushmasters are distributed in tropical forest areas of South and Central America. In Brazil they can be found in the Amazon Rainforest and the Atlantic Forest. Despite the low incidence of cases, laquetic envenoming causes severe permanent sequelae due to the high amount of inoculated venom. These accidents are characterized by local pain, hemorrhage and myonecrosis that can be confused with bothropic envenomings. However, victims of Lachesis bites develop symptoms characteristic of Lachesis envenoming, known as vagal syndrome. An important message of this bibliographic synthesis exercise is that, despite having the proteomic profiles of all the taxa of the genus available, very few structure-function correlation studies have been carried out. Therefore the motivation for this review was to fill a gap in the literature on the genus Lachesis, about which there is no recent review. Here we discuss data scattered in a number of original articles published in specialized journals, spanning the evolutionary history and extant phylogeographic distribution of the bushmasters, their venom composition and diet, as well as the pathophysiology of their bites to humans and the biological activities and possible biotechnological applicability of their venom toxins.
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Affiliation(s)
- Rafaela Diniz-Sousa
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
- Sao Lucas University Center (UniSL), Porto Velho, RO, Brazil
| | - Jeane do N. Moraes
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | | | - Cláudia S. Oliveira
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Cleópatra A. da S. Caldeira
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
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29
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Habib AG, Musa BM, Iliyasu G, Hamza M, Kuznik A, Chippaux JP. Challenges and prospects of snake antivenom supply in sub-Saharan Africa. PLoS Negl Trop Dis 2020; 14:e0008374. [PMID: 32817674 PMCID: PMC7440614 DOI: 10.1371/journal.pntd.0008374] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Abdulrazaq G. Habib
- Health Economics & Outcomes Research (H-CORE) Group, Department of Medicine, Bayero University, Kano, Nigeria
- Venom and Antivenom Research Project (VASP), Bayero University, Kano, Nigeria
- African Snakebite Research Group (ASRG) Project, Bayero University, Kano, Nigeria
- Africa Center of Excellence in Population Health and Policy, Bayero University, Kano, Nigeria
- * E-mail:
| | - Baba M. Musa
- Health Economics & Outcomes Research (H-CORE) Group, Department of Medicine, Bayero University, Kano, Nigeria
- Africa Center of Excellence in Population Health and Policy, Bayero University, Kano, Nigeria
| | - Garba Iliyasu
- Health Economics & Outcomes Research (H-CORE) Group, Department of Medicine, Bayero University, Kano, Nigeria
- Venom and Antivenom Research Project (VASP), Bayero University, Kano, Nigeria
- African Snakebite Research Group (ASRG) Project, Bayero University, Kano, Nigeria
- Africa Center of Excellence in Population Health and Policy, Bayero University, Kano, Nigeria
| | - Muhammad Hamza
- Venom and Antivenom Research Project (VASP), Bayero University, Kano, Nigeria
- African Snakebite Research Group (ASRG) Project, Bayero University, Kano, Nigeria
| | - Andreas Kuznik
- Regeneron Pharmaceuticals, Tarrytown, New York, United States of America
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